FORMS & RESOURCES

PATIENT REGISTRATION FORMS

Please complete these forms and bring them to your first appointment.

RELEASE OF PRIVATE HEALTH INFORMATION

Please complete this form if you wish to change how your personal information is disclosed.

AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION

The form must be completed by the patient when they would like a copy of their medical records provided to them or another healthcare provider. This form must also be completed by the patient when giving the Falcon Health Center permission to disclose personal health information for reasons other than treatment, payment or health care operations. There may be a charge for copies.

AUTHORIZATION TO COMMUNICATE BY EMAIL

In recognition of the fact that email is the preferred form of communication for many patients and staff, email between patients and staff is permitted within procedural guidelines intended to provide confidentiality and security to the fullest extent possible. The Authorization to Communicate by Email form must be completed, signed and returned to the Falcon Health Center prior to email communication.

HIGH SCHOOL PHYSICAL CLINIC FORMS

Please print and complete the following forms and bring to the high school physical clinic. These forms are necessary for the physical to be completed. We will be unable to see any patients that do not have completed forms.

Falcon Health

Falcon Health Center is the health center next to the Bowling Green State University (BGSU) campus.

The center serves BGSU students, faculty and staff members, as well as alumni and the community and offers walk-in urgent care, appointments with providers, whole health care, including acupuncture and chiropractic care, lab and radiology services and a full pharmacy with drive through.